Plum and Posners Diagnosis of Stupor and Coma

Hardcover | March 29, 2007

byJerome B. Posner, Clifford B. Saper, Nicholas Schiff

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Delirium, stupor and coma are common clinical states that confront clinicians in almost every medical specialty. With appropriate diagnosis and treatment, coma can often be treated successfully. Conversely, delay in diagnosis and treatment may be lethal. This monograph provides an update onthe clinical approach that was laid out in the previous 3 editions. It describes an approach for the physician at the bedside to diagnose and treat alterations of consciousness, based on pathophysiologic principles. The book begins with a description of the physiology of consciousness and thepathophysiology of disorders of consciousness. It continues with a description of the approach to a patient with a disorder of consciousness, emphasizing the bedside examination, but including the use of modern imaging techniques. The important structural and metabolic causes of coma are reviewedin detail. It then describes the emergency treatment, both medical and surgical, of patients with specific disorders of consciousness and their prognosis. New chapters describe the approach to the diagnosis of brain death and the clinical physiology of the vegetative state and minimally consciousstate, as well as the ethics of dealing with such patients and their families. The book is aimed at medical students and residents, in fields from internal medicine and pediatrics to emergency medicine, surgery, neurology, neurosurgery, and psychiatry, who are likely to encounter patients with disordered states of consciousness. It includes historical background and basicneurophysiology that is important for those in the clinical neurosciences, but also lays out a practical approach to the comatose patient that is an important part of the repertoire of all clinicians who provide emergency care for patients with disorders of consciousness.

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Delirium, stupor and coma are common clinical states that confront clinicians in almost every medical specialty. With appropriate diagnosis and treatment, coma can often be treated successfully. Conversely, delay in diagnosis and treatment may be lethal. This monograph provides an update onthe clinical approach that was laid out in t...

Jerome B. Posner is Evelyn Frew American Cancer Society Clinical Research Professor, Memorial Sloan Kettering Cancer Center. Fred Plum is University Professor, Department of Neurology, Weill Medical College, Cornell University. Clifford B. Saper is Professor at the Beth Israel Deaconess Hospital and Harvard Medical School. Nicholas Sc...

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Format:HardcoverDimensions:400 pages, 7.09 × 10.12 × 0.91 inPublished:March 29, 2007Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0195321316

ISBN - 13:9780195321319

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Table of Contents

Preface to the Fourth Edition. 1. Pathophysiology of Signs and Symptoms of ComaAltered States of ConsciousnessDefinitionsAcutely Altered States of ConsciousnessSubacute or Chronic Alterations of ConsciousnessApproach to the Diagnosis of the Comatose PatientPhysiology and Pathophysiology of Consciousness and ComaStructural Lesions that Cause Altered Consciousness in HumansPhysiology and Pathophysiology of Consciousness and Coma2. Examination of the Comatose PatientOverviewHistoryGeneral Physical ExaminationLevel of ConsciousnessABC: Airway, Breathing, CirculationCirculationRespirationPupillary ResponsesExamine the pupils and their responsesPathophysiology of pupillary responses: Peripheral anatomy of the pupillomotorPharmacology of the peripheral pupillomotor systemLocalizing value of abnormal pupillary responses in patients in comaMetabolic and pharmacological causes of abnormal pupillary responseOculomotor ResponsesFunctional anatomy of the peripheral oculomotor systemFunctional anatomy of the central oculomotor systemThe ocular motor examinationInterpretation of abnormal ocular movementsMotor ResponsesMotor toneMotor reflexesMotor responsesFalse Localizing Signs in Patients with Metabolic ComaRespiratory responsesPupillary responsesOcular motor responsesMotor responsesMajor Laboratory Diagnostic AidsBlood and urine testingComputed Tomographic Imaging (CT) and Angiography (CTA)Magnetic Resonance Imaging (MRI) and Angiography (MRA)Magnetic Resonance Spectroscopy (MRS)Lumbar PunctureElectroencephalography (EEG) and Evoked Potentials3. Structural Causes of Stupor and ComaCompressive Lesions as a Cause of ComaCompressive lesions may directly distort the arousal systemHerniation syndromes: Intracranial shifts in the pathogenesis of comaDestructive lesions as a cause of comaDiffuse, bilateral cortical destructionDestructive disease of the diencephalonDestructive lesions of the brainstem4. Specific Causes of Stupor and ComaIntroductionSupratentorial Compressive LesionsEpidural, Dural, and Subdural MassesSubarachnoid LesionsIntracerebral MassesInfratentorial Compressive LesionsEpidural and Dural MassesSubdural posterior fossa compressive lesionsSubarachnoid posterior fossa lesionsIntraparenchymal posterior fossa mass lesionsSupratentorial destructive lesions causing comaVascular causes of supratentorial destructive lesionsInfections and inflammatory causes of supratentorial destructive lesionsConcussion and other Traumatic Brain InjuriesInfratentorial Destructive LesionsBrainstem vascular destructive disordersInfratentorial inflammatory disordersInfratentorial tumorsCentral pontine myelinolysis5. Multifocal, Diffuse, and Metabolic Brain Diseases Causing Delirium, Stupor, or ComaClinical Signs of Metabolic EncephalopathyConsciousness: Clinical AspectsRespirationPupilsOcular MotilityMotor ActivityDifferential DiagnosisAspects of Cerebral Metabolism Pertinent to ComaCerebral Blood FlowGlucose MetabolismAnesthesiaMechanisms of Irreversible Anoxic Ischemic Brain DamageEvaluation of Neurotransmitter Changes in Metabolic ComaSpecific Causes of Metabolic ComaIschemia and HypoxiaDisorders of Glucose or Cofactor AvailabilityDiseases of Organ Systems Other than BrainExogenous IntoxicationsAbnormalities of Ionic or Acid-Base Environment of the CNSDisorders of thermoregulationInfectious Disorders of the Central Nervous System:BacterialInfectious Disorders of the Central Nervous System: ViralCerebral Vasculitis and Other VasculopathiesMiscellaneous Neuronal and Glial DisordersAcute Delirious States6. Psychogenic UnresponsivenessConversion ReactionsCatatoniaPsychogenic seizuresCerebellar Cognitive Affective Syndrome"Amytal interview"7. Approach to Management of the Unconscious PatientA Clinical Regimen for Diagnosis and ManagementPrinciples of Emergency ManagementExamination of the PatientGuides to Specific ManagementA Final Word8. Brain DeathDetermination of Brain DeathClinical Signs of Brain Death9. Prognosis in Coma and Related Disorders of Unconsciousness, Mechanisms Underlying Outcomes, and Ethical ConsiderationsIntroductionPrognosis in comaPrognosis by disease stateVegetative stateMinimally conscious stateLocked-in stateMechanisms underlying outcomes of severe brain injury: neuroimaging studies and conceptual frameworksFunctional imaging of the persistent vegetative statePotential mechanisms underlying residual functional capacity in severely disabled patientsEthics of Clinical Decision Making and Communication with Surrogates (J.J. Fins)Surrogate Decisionmaking, Perceptions and NeedsProfessional Obligations and Diagnostic DiscernmentTime-delimited Prognostication and Evolving Brain States: Framing the ConversationFamily Dynamics and Philosophical ConsiderationsIndex.

Editorial Reviews

"Plum and Posners Diagnosis of Stupor and Coma is an essential text for the practicing neurologist, for the general intensivist or hospitalist, for the neurointensivist or neurosurgeon, and for the many students, residents, and fellows in the neurosciences. It stands the test of time,highlighting the legacy of Drs Plum and Posner, who have contributed so much to the field of neurology and to the training of generations of neurologists."--Wade Smith, Annals of Neurology